I am lucky, I have just been for my annual mammogram and breast cancer check up and I have learned that I am still clear of this horrible disease. It is now 5 years since I was diagnosed and treated for breast cancer. 5 years clear: wonderful. However, that does not mean I am treatment free. I have been taking Letrozole for these first five years. The side effects of that drug are many and various. I think I suffered all of them, except high blood pressure! Anyway, the oncologist says it is time to move on from Letrozole to Tamoxifen.

Tamoxifen is another form of hormone treatment, known as endocrine therapy, for those who have had breast cancer. It is only prescribed if the breast cancer had receptors within the cell that bind it to oestrogen. All breast cancers are tested for oestrogen using tissue from a biopsy or after surgery. My tumour was found to be HER2+ and, as this can stimulate cancer tumours to grow, Tamoxifen is prescribed to help stop any cancer cells from growing.

If you are found to be hormone receptor negative, then Tamoxifen will not be of any benefit to you.

Primary breast cancer, which has not spread beyond the breast and lymph glands, may be treated with Tamoxifen after surgery. The lymph glands are under your arms. Tamoxifen is used as additional treatment to reduce the risk of the cancer returning and also to reduce the risk of new cancers developing. This is called adjuvant therapy.

Occasionally, Tamoxifen may be used as the first treatment for breast cancer. This may be when surgery is not appropriate or before surgery to shrink a large breast cancer tumour. Shrinking a large tumour in this way may mean that a mastectomy (breast removal) may be avoided and a lumpectomy (removal of the tumour and surrounding tissue) may be sufficient treatment. Also, Tamoxifen may be used for breast cancer that has returned into the breast or surrounding area. It can also be used if you are diagnosed with secondary breast cancer. This is when cancer cells from the breast have spread to other parts of the body.

In some instances, Tamoxifen may be an option for some people who have a high risk of developing breast cancer because of family history of the disease. This is in order to reduce the risk of development of breast cancer.

Tamoxifen is usually taken as a tablet, but may be prescribed as a liquid for those who find swallowing difficult. The recommended dose for the majority of people is 20mg. It is best to take one at the same time each day, but, if you miss a dose, it is not necessary to take an extra tablet because there will be a high enough level of the drug in your body from the previous day.

Usually, you will be prescibed Tamoxifen for a period of between 5 and 10 years. I have been told I should take the drug for a 5 year period. So, here goes, Tamoxifen here I come!

It is hard to imagine a treatment that only lasts a few seconds, minutes if you count the set up time, causing after effects. Believe me when I tell you that it does. There are side effects of any medical treatments, of course. With radiotherapy these can be quite frightening. There is some concern that after treating the brain (particularly if combined with chemotherapy) the patient may develop memory problems.

Radiation therapy works by damaging the DNA (genes) of tumour cells. DNA damage stops tumour cells from dividing, growing and spreading. Radiotherapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than most normal cells around them. Although some normal cells are affected by radiation, most normal cells appear to recover more fully from the effects of radiation than do cancer cells. Radiation oncologists carefully limit the intensity of treatments and the area being treated so that the cancer will be affected more than the normal tissues. This is why the set up for the treatment often lasts longer than the treatment itself.

Modern radiotherapy has advanced dramatically over the recent years. It is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the areas of tumour while sparing most adjacent normal tissues even in seemingly complicated and difficult parts of the body.

Radiotherapy affects different people to greater or lesser extents. My friend Ismay, who is a real inspiration to me, is facing terminal cancer with and bravery that is awe-inspiring. She found the radiotherapy to her head (to shrink a brain tumour) really difficult. She was left with burns to her scalp. Her hair that had grown back after chemotherapy, was lost again and the burns to her head made it impossible to wear her wig for weeks. The pain and distress were hard to bear: but bear it she did. along with some forgetfulness, with her relentless courage and humour.

My treatment was to my right breast. It was targeted to the area from which my tumour had been removed. I had been told the radiotherapy would make me feel tired. I had also been told the effect was cumulative. Unsurprisingly, me being me, when I felt no particular effects after the first dose or so, I felt I had beaten the system. I had been told the cumulative effects would also include burning to my skin. Again, initially, I deduced my skin was different to everybody else’s. It is not. However, the effects do not kick in immediately, but do last a long time after the treatment has finished.

I have found the after effects of the radiotherapy quite depressing. The burning under my breast was soothed by aqueous cream but the skin burnt and peeled the way it might with sunburn. I am now six moths out after radiotherapy has finished. The burns are healed but my breast still looks tanned compared to the other and I still find I get tired far faster than I expected this far on. I still cannot walk as far as I used to. One of my favourite hobbies is dancing, but I cannot dance for as long or as energetically as I did before my treatment.

I continue to find it difficult to concentrate for prolonged periods and the exhaustion is debilitating. I was becoming increasingly upset about this and was speaking to my friend Margaret. Margaret survived breast cancer and got her all clear about eighteen months ago. She has been immensely supportive during my cancer journey. The wonderful Margaret told me that, even yet, she gets bone tired sometimes. It is not like the tiredness you feel after a busy day or a late night. It is a wave of weariness that is all encompassing. The big problem is it can arrive, unannounced, at any time. So I have no confidence that, if I start a long or complicated task, I will have the energy to finish it. This is what I find most exasperating.

However, the side effect that I had feared most was depression. When the radiotherapy comes to an end, you come off the treatment merry-go-round. All the attention stops and this can cause the depression the doctors and nurses warned me about. I suppose when you have been using all your energies to defeat this disease, when it comes to an end so suddenly, it can result in an emotional vacuum. I have mental health problems anyway and I really feared this problem. I was lucky, it did not happen to me. Other friends were not so lucky. They did feel the sudden stop of treatment and attention left a void that led to depression.

Now I am at the stage where I get check up appointments with the consultant approximately every three months. Before I see the consultant I go to the hospital for an echo scan. It is also called an echo-cardiogram is an ultrasound scan of the heart. It is sometimes just called an ‘ECHO’. Ultrasound is a very high-frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves. An ECHO can be carried out for many different reasons. I have it done to check how well your heart is working after the radiotherapy and to look at how well the valves are moving inside the heart. An ECHO can also help to see any fluid that may have collected around the heart. So far my heart is holding up well.

I need to undress to the waist and lie on the couch. A probe is placed on my chest (it is a bit like a very thick blunt pen). Also, lubricating jelly is put on the probe so it makes good contact with the skin. The probe is connected by a wire to the ultrasound machine and monitor. Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo (‘bounce back’) from the heart and various structures in the heart. They make a sort of swooshing noise.

The consultant also arranges for my blood to be checked to make sure my calcium and haemoglobin levels are high enough. So far, so good. This is especially important because for the next five years I require to take a medication known as letrozole. Amongst the more common side effects of letrozole are hot flushes, hair loss, joint and bonepain, muscle pain, tiredness, unusual sweating, nausea, diarrhea, dizziness, and trouble sleeping. I have certainly suffered the tiredness as well as the joint, bone and muscle pain. I was told by other patients it should lessen after 8-10 months. The doctors have not confirmed this!

So I have complained about my difficulties and honestly reported my progress. I am aware that I am very lucky. The disease was diagnosed early after a mammogram. The necessary surgery was carried out quickly. I am to get another mammogram later this month to confirm that I continue to survive breast cancer now.

Some days are better than others. Wednesday 25 April was a busy day. I spent the first half of it shuffling from one doctor to another. My first appointment was at my GP just for a regular check-up. It was then I was able to tell my GP that I had been recalled after my mammogram. He was quite cross that the hospital had not informed him. The GP also wanted to speak to me about the length of time I had been taking hormone replacement therapy (HRT). It was a long time, over 12 years. However, in light of the other appointment I had to attend later in the morning he decided not to make any changes at this point.

When I came back out of the surgery, I phoned my husband and he drove me on to my next medical appointment of the day. This, again was a regular appointment. It was my fortnightly visit to my psychologist. It is, perhaps, also ironic that I did not believe in depression until I was diagnosed with it over 10 years ago. Like many people, I thought it was not truly an illness, but a state of mind that could be surmounted simply by “pulling yourself together”. I cannot help but think a higher being was having a laugh when they got their own back and I have battled depression, without surmounting it, for so many years now.

However, when the psychologist asked how I felt about the possibility of a diagnosis of cancer, I still could not truly admit that it might, even now happen to me. So I put on my mask, as I so often do when faced with a problem too difficult to face, and told her that I did not know how to feel, until I knew what I had to face. It sounds sensible, but really, I simply could not release my emotions or inhibitions: not then, not yet.

When my husband and I walked from the psychology department of the hospital to the breast cancer care department we went quite slowly. Almost as if by not knowing the results of the biopsy and screening it would prevent the news from being bad.

We were not kept waiting long before I was called through to meet with the doctor and my husband came with me. None of the staff that I had seen the previous week were at the clinic that day. It was a little daunting to know I was to get the results from someone I had never met before. However, the doctor introduced herself and the cancer nurse assigned to me was there and introduced herself too. She is Angela Watson.

It was explained to us that the biopsy had shown the tumour to be cancerous. It was explained to me that the disease had been found early and the tumour was about half the size of a baked bean. (I have always seen myself more as a “petit pois” kind of girl!) The doctor told me I would need to have surgery, a lumpectomy, (such an ugly word) to remove the tumour. I was given an appointment to meet with the surgeon on Friday and that I would probably go for surgery in 2-3 weeks. What a lot of information.

I was told the tumour was found to be HER-2 positive and that I should stop my HRT with immediate effect. HER2 is a protein found on the surface of certain cancer cells. Some breast cancers have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. Knowing if a cancer is HER2-positive can sometimes affect the choice of treatment. Women with HER2-positive breast cancer can benefit from a drug called trastuzumab (Herceptin). Herceptin only works in people who have high levels of the HER2 protein.

To understand HER2, it first helps to know a little about receptors and growth factors:

Receptors are particular proteins that are present within cells or on their surface. Other proteins or chemicals in the body can attach to these receptors to bring about change within a cell (for example, to make it reproduce or repair itself).

Growth factors are chemicals that attach to these receptors and stimulate cells to grow.

HER2 is a receptor found on the surface of certain cancer cells. It is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor called human epidermal growth factor, which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow.

Some breast cancer cells have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. It is thought that about 1 in 5 women with breast cancer will have HER2 positive tumours. So roll on Friday and then I get to hear what the surgeon has to advise, but I am not ashamed to say, I have had better days.

It is true that, at the end of the breast screening session at which I had my first mammogram, the radiographers did tell me that some people are recalled to have their mammogram results checked. It is also true that I did not pay a great deal of attention to that. Breast cancer could not happen to me, could it?

This is partly because I knew the staff had reached the end of their day and I did not want to hold them back. It was also because having a mammogram is not a very pleasant procedure, so I just wanted to get back to my husband waiting patiently in the car and go home. Most importantly, it was because I discounted the information: I was sure the breast cancer was not going to affect me. The mammogram was just a precaution.

I have already explained, my mind set, breast cancer did not happen to me. Imagine my irritation when I got a notification for recall after the screening. It was clear to me that there must be a mistake. Perhaps the radiographer had been in such hurry to get home as my appointment has been the last one of the day, that she had made a mistake. It must be a mistake……………………..

Breast cancer can affect anyone, man or woman. Breast cancer affects
1 in 10 women in Scotland at some time in their life. It is
known that if breast cancer is found at an early stage,
treatment has the greatest chance of being successful.
The best way of screening for breast cancer is by having
regular mammograms, as you may not be able to see or feel any early changes to your breasts.

So on 19 April I attended the breast screening centre. The correspondence I received in relation to the breast screening explained that the series of tests and examinations could take several hours. My long suffering husband did take me to the hospital, however, he did not sit and wait around. That is too hard for anybody.

This area of the hospital has been refurbished and is bright. The staff, without exception, are supportive, cheerful and professional. The patients remove their upper clothing and wear little pink shawls which will never win a design award, but are convenient, bearing in mind the examinations they will undergo.

The tests I was subjected to during this recall were, first of all another mammogram. By now I was paying more attention. A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called “benign,” but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

In addition to this the doctor required me to have an ultra sound. The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography or breast magnetic resonance imaging (MRI).

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area. When an ultrasound examination reveals a suspicious breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures. An ultrasound exam will usually need to be performed before the biopsy in order to plan the procedure and to determine if this method of biopsy can be used.

The doctor could not find the shadow that he saw on the mammogram in the ultra sound scan, so he did decide to try to burst the shadow, but when that did not work he decided to have biopsies taken. The nurse who took the biopsies was very skilled. She managed to take 12 biopsies from a nip on my breast no bigger than the size of the top of a pin.

The visit took a total of almost 3 hours. At the end of it the doctor explained that he could not tell if the shadow he saw was benign or not. When he asked me if I had any questions, all the questions were dependent on the shadow being a cancerous tumour. Therefore I chose not to ask anything. At this point even I began to have doubts, maybe breast cancer could happen to me. Make sure you get checked regularly.

This wicked, shamed disease is no respecter of dignity. It could happen to you.

You have to appreciate the mind set. It couldn’t happen to me………… I could not be one of those statistics. There was no question of me suffering breast cancer. So when I was sent an appointment for a mammogram, I was more concerned about the convenience of the time slot; the embarrassment factor of getting my tits out and the pain and indignity of the process. At no time did I consider what a remarkable machine has been developed and what skilled people interpret the results. It never occurred to me that this could be a significant event.

When you have a mammogram, a skilled technologist positions and compresses your breast between two clear plates. The plates are attached to a highly specialized camera, which takes two x-rays of the breast from two directions. Then the technologist repeats the technique on the opposite breast. For some women, more than two pictures may be needed to include as much tissue as possible.

Mammography can be painful for some women, but for most it is just mildly uncomfortable, and the sensation lasts for just a few seconds. Compressing the breast is necessary to flatten and reduce the thickness of the breast. The x-ray beam should penetrate as few layers of overlapping tissues as possible. From start to finish, the entire procedure takes about 20 minutes. A diagnostic mammogram generally takes more time than a screening mammogram because it takes more pictures from more angles.

So, having rearranged the date and time to one that suited me, I was the last appointment in the mobile breast screening unit on 22 March. I was greeted with a smile and made to feel as comfortable as possible before the screening began. While the unit was effectively a modified caravan in a health centre car park, the female radiographers could not have been more courteous or professional.

This is not a dignified process. It is uncomfortable. However, it is worth swallowing your pride, put aside your embarrassment and shame, because, you see, those suffering from breast cancer are not statistics. It could, and did, happen to me: in fact, whether you are a man or a woman, it could even happen to you.